Nasal turbinate hypertrophy is the chronic enlargement of the turbinates (or nasal conchae), structures lining the inside of the nasal passages. Turbinates play an important role in preparing inhaled air for the lungs. When they become chronically inflamed and too large, the resulting nasal obstruction reduces the space available for air to flow. This leads to a persistent feeling of stuffiness.
The Role of Nasal Turbinates
The nasal cavity contains three pairs of turbinates—the superior, middle, and inferior—which are curved, bony shelves covered by soft tissue rich in blood vessels. Their function is to condition the air before it reaches the lower respiratory tract. They achieve this by filtering out particles, warming the air, and adding moisture to prevent dryness in the airways. Turbinates regulate airflow by swelling and shrinking in response to the environment, a process called the nasal cycle. The inferior turbinates are the largest and are most commonly affected by chronic enlargement, leading to inferior turbinate hypertrophy.
Primary Causes of Turbinate Enlargement
Turbinate enlargement is a chronic reaction to inflammation or structural issues within the nasal passages.
Inflammatory Causes
Chronic allergic rhinitis is a frequent cause, where repeated exposure to allergens like dust mites or pollen triggers inflammation. This causes the mucosal lining of the turbinates to become thick and permanently enlarged. Non-allergic rhinitis, sometimes called vasomotor rhinitis, involves chronic nasal inflammation not related to specific allergens. This condition is often due to dysregulation of the nerves controlling blood vessels in the nasal lining, leading to chronic swelling. Environmental irritants, such as continuous exposure to cigarette smoke, air pollution, or chemical fumes, also act as triggers that cause the turbinate tissue to thicken.
Structural Causes
Structural issues can also lead to enlargement, particularly a deviated nasal septum, which is a misalignment of the wall separating the nasal cavities. When the septum is crooked, it restricts airflow on one side. This often causes the turbinate on the opposite, wider side to enlarge, known as compensatory hypertrophy. This swelling attempts to regulate airflow dynamics in the newly widened passage. Prolonged or repeated sinus infections also contribute to the ongoing inflammation that results in chronic hypertrophy.
Recognizing the Signs of Hypertrophy
The most noticeable sign of turbinate hypertrophy is persistent nasal obstruction, which is often described as a stuffy or blocked nose that does not resolve. This blockage may alternate between the left and right nostrils or be worse on one side, especially if a deviated septum is also present. The constant inability to breathe comfortably through the nose often forces the patient to breathe through their mouth, particularly at night.
Mouth breathing during sleep frequently leads to snoring and can contribute to other sleep disturbances. Patients often wake up with a dry mouth and may experience a reduced sense of smell, known as hyposmia, because the swollen turbinates block odor molecules from reaching the olfactory region. A doctor typically confirms the diagnosis by performing a visual inspection, often using a small camera called a nasal endoscope to directly view the enlarged turbinates and assess the extent of the blockage.
Medical and Surgical Management Options
Initial treatment for turbinate hypertrophy focuses on conservative, non-invasive medical management aimed at reducing the underlying inflammation. Topical intranasal corticosteroid sprays are considered the first line of therapy, as they deliver potent anti-inflammatory agents directly to the swollen mucosal tissue. These sprays work to shrink the soft tissue lining, thereby increasing the space available for airflow.
Further medical options include antihistamines, which address the inflammatory response if the cause is allergic rhinitis, and regular use of saline nasal rinses. Saline irrigation helps to clear mucus and reduce surface irritants, supporting the anti-inflammatory effects of the medications. In cases where the turbinate enlargement is resistant to medication, or if there is a significant bony component to the hypertrophy, a surgical intervention may be recommended.
The goal of surgical reduction is to decrease the size of the turbinate while carefully preserving its mucosal lining and function. Minimally invasive procedures are common, such as radiofrequency ablation, which uses heat energy to create controlled scarring and shrinkage within the turbinate tissue. Another technique is submucosal resection, where a microdebrider or other specialized instrument is used to remove or reduce the deeper, submucosal tissue and bone beneath the surface membrane. These surgical methods are often performed as outpatient procedures and can be combined with other airway surgeries, such as septoplasty, to provide comprehensive relief from chronic nasal obstruction.